Chronic Disease

Provider-patient dialogue could be improved to foster medication adherence in HIV care

Patients' failure to take medications as prescribed often results in failure to meet treatment goals. Even in the case of antiretroviral (ARV) therapies for HIV, where successful treatment is life-saving, many people do not consistently take their medications as prescribed. One concern is that provider communication with patients about medication adherence may not be effective in promoting better adherence.
Researchers analyzed voice recordings of 45 providers interacting with 415 patients with AIDS during clinical visits. Three main findings emerged. First, about 10 percent of utterances concerned antiretroviral treatment, and among those using but reporting non-adherence to ARVs, only about 23 percent of utterances had any ARV problem-solving dialogue. Second, when engaged in ARV problem-solving dialogue, providers used significantly more directives and controlling speech. Third, overall, providers asked relatively few open questions or few questions that elicited patient opinions, values or preferences, and only rarely did they check patients' understanding.
The researchers note that these speech patterns may not be consistent with the concepts of patient-centeredness and shared decisionmaking. However, they also point out that patients with HIV often have a variety of social and clinical problems that make their care a tremendous challenge for providers. It is not surprising, they suggest, that in this context, physicians speak more than patients, tend to ask relatively few open or expressive questions, and rarely check patients' understanding.
The researchers concluded that more effective dialogue would likely result in better treatment outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS13903).
See "Provider-patient adherence dialogue in HIV care: Results of a multisite study," by M. Barton Laws, Ph.D., Mary Catherine Beach, M.D., Yoojin Lee, M.S., M.P.H., and others in AIDS Behavior, published online January 31, 2012.

— MWS